Term
| When is case history completed? |
|
Definition
| At the end of the exam. Always be taking in information/observing |
|
|
Term
| What are advantages of graphical analysis? |
|
Definition
Allows visualization of phoria / vergence / AC/A / PRA/NRA
Easily spot patterns/erroneous findings |
|
|
Term
| What are disadvantages of graphical analysis? |
|
Definition
Does not plot accomodation/facility
Cumbersome to use
Uses criteria such as Sheard's and Percival's to determine if a problem exists |
|
|
Term
| What are advantages of OEP? |
|
Definition
| The concept that the visual system can deteriorate over time but that that deterioration can be prevented |
|
|
Term
| What are disadvantages of OEP? |
|
Definition
MUST follow protocols
cumbersome
Strange language |
|
|
Term
| What is the advantage of normative analysis? |
|
Definition
Uses clinically established norms and deviations
Looks at groups of findings rather than individual |
|
|
Term
| What is the disadvantage of normative analysis? |
|
Definition
|
|
Term
| What are the advantages of fixation disparity curves? |
|
Definition
| Findings are found under binocular conditions |
|
|
Term
| What are disadvantages of fixation disparity curves? |
|
Definition
| Little information on accommodation |
|
|
Term
| How are PRA/NRA nets calculated? |
|
Definition
For PRA, find BI AC/A. Divide BI(B) value by BI AC/A. This is the net IF vergence is limiting PRA
For NRA, repeate process only using BO AC/A |
|
|
Term
| What is Dr Smith's maxim about hyperopic refraction problems? |
|
Definition
| Every hyperopic refraction problem has a cycloplegic solution |
|
|
Term
| What are the four guidelines for a cycloplegic refraction? |
|
Definition
1) Manifest refraction should be performed before cycloplegia
2) Perform ANYTIME there are variable results in refraction
3) Perform when s/sx and refraction are disproportionate
4) Perform on first examination of every child |
|
|
Term
| What are the acceptable residual accommodation amounts after cycloplegia by age? |
|
Definition
>20yo: <2.0D
20-40yo: <1.5D
>40yo: <1.0D |
|
|
Term
| What are the doses for atropine by age? |
|
Definition
0.25% TID x 2 days <1 yo
0.5% TID x 2 days 1<3 yo
1.0% TID x 2 days 3<6 yo |
|
|
Term
| What are the doses for cyclopentolate? |
|
Definition
3 gtt 0.2% cyclopentolate w/ 0.5% phenyl for neonates
2 gtt 0.5% cyclopentolate up to 6 months
1 gtt drop 1% cyclopentolate >6mo |
|
|
Term
| What is the doses for tropicamide? Is it a good cycloplegic? |
|
Definition
2 gtt 1.0% >40 yo
However, very poor cycloplegic agent |
|
|
Term
| If a cycloplegic refraction is performed on someone with large pupils, what RE may be found erroneously? |
|
Definition
| Minus RE in manifest refraction that is not truly there |
|
|
Term
| After finding a cycloplegic refraction, what should be checked? |
|
Definition
|
|
Term
| Define PE. How is it converted into SD? |
|
Definition
PE is Probable Error and +- 1 PE should cover half of the population for a given measurement
To convert to SD, divide PE by 0.6745. To convert SD --> PE multiply SD by 0.6745 |
|
|
Term
| What are the normal ranges for standard scores (SS)? |
|
Definition
|
|
Term
| What is a standard score? |
|
Definition
| a score that converts individual tests with different means/standard deviations into numbers that can be directly compared to one another for normalcy |
|
|
Term
| What is the equation for standard score? |
|
Definition
|
|
Term
| How are standard score converted to Z scores? |
|
Definition
| Since standard score is based on probable error and Z scores are based on standard deviation, multiply SS by 0.6745 to obtain Z score. |
|
|
Term
| What is a physiological finding? What are they also referred to as? |
|
Definition
| Physiological findings are graded on a continuum where more is better. Also known as Type 1 findings |
|
|
Term
| What type of tests are considered physiological or Type 1 findings? |
|
Definition
AA
NPC
PRA
NRA
BI/BO ranges
Vergence/accommodation facility |
|
|
Term
| What are postural findings? What are they also known as? |
|
Definition
| Postural findings are scaled on a continuum where there is an ideal, 'just right' number and anything higher or lower can be abnormal/negative. Also known as Type II findings |
|
|
Term
| What type of tests are considered postural findings or Type II findings? |
|
Definition
X-cyl
Dynamic Ret
AC/A
phorias
Fixation Disparity (FD) |
|
|
Term
|
Definition
| A meta score based on the sum of point scores derived from standard scores of a number of tests. |
|
|
Term
| How is an index score calculated? |
|
Definition
| Run testing --> convert scores into SS --> use table to convert SS into PS based on Type 1 or Type 2 findings --> Sum the PS and divide by # of tests performed --> Multiply by 10 to obtain index score |
|
|
Term
| What point score is assigned for normal findings in Type 1 standard scores? Type 2 standard scores? |
|
Definition
| Both are assigned a value of 3 points if in the normal ranges |
|
|
Term
| What are the two advantages of index scores? |
|
Definition
Allows before and after comparisons
Describes a large number of scores with a single numerical score |
|
|
Term
| How were the norms and PE for normative analysis derived? |
|
Definition
| From a young, healthy, non-presbyopic popultion |
|
|
Term
| When is normative analysis useful clinically? |
|
Definition
| Monitoring changes from changing spx Rx's or progress from VT |
|
|
Term
| What deviation, if not detected will affect all exam results? |
|
Definition
|
|
Term
| Yoked prism can affect perceived distance. How? |
|
Definition
BU makes things appear closer
Downgaze is perceptually tied in with close work |
|
|
Term
| What are 4 conditions that may require prism? |
|
Definition
High phorias w/ reduced ranges
Strab (training or cosmesis)
Field loss
VT |
|
|
Term
| What are 4 general tests to assess if prism is needed? |
|
Definition
Krimsky (Hirschberg w/ prism bar)
Hirschberg
Covert Test
Red Lens |
|
|
Term
| When performing a cover test, what must be controlled carefully? |
|
Definition
|
|
Term
| How is a Red Lens test response graded? |
|
Definition
4 levels:
Grade One: 1 light and its pink
Grade two: two lights, oh, no one light, um, two lights . . .
Grade 3: Two lights (one red, one white)
Grade 4: See one light, either red or white |
|
|
Term
| When measuring Hirschberg, what landmarks are used to quantify reflex position? |
|
Definition
| Pupil is 4mm in diameter and cornea is 10mm in diameter therefore a reflex on the edge of the pupil is 2mm from center. A reflex on the limbus is 5mm from the center. Assume 22 p.d. per mm. |
|
|
Term
| When Dr Smith describes a test as 'soft' what does he mean? |
|
Definition
| A soft test requires very little patient response, the more pt response, the less 'soft' it is. |
|
|
Term
| What are the two best ways to determine if prism is needed and how much? |
|
Definition
| Vectograph or disparometer/fixation disparity curve |
|
|
Term
| What are the 5 ways to determine if prism is needed? |
|
Definition
Maddox rod
Von graefe phorias
BI/BO ranges ran through comfort criteria
Vectograph
FD |
|
|
Term
| What are the 4 ways to incorporate prism into a lens? |
|
Definition
ground in
induced
Fresnel
slab off |
|
|
Term
| What is the limit of prism that can be ground into a lens? |
|
Definition
|
|
Term
| What are the three normal AC/A conditions that require prism to correct? |
|
Definition
Basic Exo
Basic Eso
Fusional vergence dysfxn |
|
|
Term
| What are basic considerations for low AC/A conditions? |
|
Definition
poor prism adaptation --> accepts prism Rx well (at the distance of the deviant measure)
Accommodation has little effect on vergence posture --> (+) or (-) lenses have minimal tx value |
|
|
Term
|
Definition
blur
frontal HA
asthenopia
lateral diplopia at near
fatigue,pulling
loss of place reading, decreased comprehension
sleepiness |
|
|
Term
| What are deviant findings associated with CI? |
|
Definition
reduced NPC
Reduced BO range, especially recovery
High XP' and low AC/A
Low X-cyl(B), NRA, near retinoscopy, (+) flipper facility |
|
|
Term
|
Definition
viral illness
MG
MS
Parkinson's Dz
Ischemic infarction
trauma
space occupying lesions
False CI (secondary to AI) |
|
|
Term
| How do you d/dx Basic XP from CI? |
|
Definition
Basic XP --> normal AC/A
Less than 1 SS difference between near/far exophoria |
|
|
Term
|
Definition
Correct ametropia
Correct vertical imbalances if necessary
VT for suppression
VT for sensory motor function
Horizontal prism
Plus lenses
Surgery |
|
|
Term
| What are the s/sx of false CI? |
|
Definition
| Same as CI (see other slide for list) |
|
|
Term
| What are the deviant findings associated with false CI? |
|
Definition
Does NOT present with reduced NPC
High XP' and low AC/A
Higher BO ranges than true CI, lower BI ranges relative to phoria
High X-cyl(B), NRA
GOOD facility with (+) flippers
Reduced PRA and (-) flipper facility |
|
|
Term
| How is false CI d/dx'd from CI? |
|
Definition
normal accommodative amplitude
reduced BO(N)
Low plus acceptance |
|
|
Term
|
Definition
correct ametropia
correct vertical
plus lenses
VT for accommodation --> expect phoria to swing back into place
Possibly horizontal prism |
|
|
Term
|
Definition
HA and asthenopia
motion sickness
diplopia in low levels of light
light sensitivity |
|
|
Term
| What findings are deviant in DI? |
|
Definition
EP > EP' (more than 1 SS)
Reduced BI(K) and BI(R) at distance |
|
|
Term
|
Definition
6th nerve palsy
Basic EP (will have normal AC/A, EP--> EP' less than 1 SS difference) |
|
|
Term
| How will a 6th nerve palsy present? |
|
Definition
sudden with noncomitant deviation
Endpoint nystagmus |
|
|
Term
|
Definition
correct ametropia
Correct any vertical
Horizontal prism
VT for suppression and sensory motor fxn
surgery |
|
|
